Page 40 - HIV/AIDS Guidelines

burden, drug interactions, and potential side effects. Regimens should be tailored for the individual patient to
enhance adherence and thus improve long-term treatment success. Individual regimen choice is based on
such considerations as expected side effects, convenience, comorbidities, interactions with concomitant
medications, and results of pretreatment genotypic drug-resistance testing.

Pretreatment Drug-Resistance Testing
Current studies suggest a 6%–16% prevalence of HIV drug resistance in ART-naive patients, 25-29 and some
studies suggest that the presence of transmitted drug-resistant viruses may lead to suboptimal virologic
30
responses. Therefore, pretreatment genotypic resistance testing should be used to guide selection of the
most optimal initial ARV regimen. (See Drug-Resistance Testing.)

Improving Adherence
Suboptimal adherence may result in reduced treatment response. Incomplete adherence can result from
complex medication regimens; patient factors, such as active substance abuse and depression; and health
system issues, including interruptions in patient access to medication and inadequate treatment education and
support. Conditions that promote adherence should be maximized before and after initiation of ART. (See
Adherence to Antiretroviral Therapy.)

References

1. Dinoso JB, Kim SY, Wiegand AM, et al. Treatment intensification does not reduce residual HIV-1 viremia in patients on
highly active antiretroviral therapy. Proc Natl Acad Sci U S A. Jun 9 2009;106(23):9403-9408.
2. Chun TW, Engel D, Berrey MM, Shea T, Corey L, Fauci AS. Early establishment of a pool of latently infected, resting
CD4(+) T cells during primary HIV-1 infection. Proc Natl Acad Sci U S A. Jul 21 1998;95(15):8869-8873.
3. Chun TW, Stuyver L, Mizell SB, et al. Presence of an inducible HIV-1 latent reservoir during highly active antiretroviral
therapy. Proc Natl Acad Sci U S A. Nov 25 1997;94(24):13193-13197.
4. Finzi D, Hermankova M, Pierson T, et al. Identification of a reservoir for HIV-1 in patients on highly active antiretroviral
therapy. Science. Nov 14 1997;278(5341):1295-1300.
5. Finzi D, Blankson J, Siliciano JD, et al. Latent infection of CD4+ T cells provides a mechanism for lifelong persistence
of HIV-1, even in patients on effective combination therapy. Nat Med. May 1999;5(5):512-517.

6. Wong JK, Hezareh M, Gunthard HF, et al. Recovery of replication-competent HIV despite prolonged suppression of
plasma viremia. Science. Nov 14 1997;278(5341):1291-1295.

7. Siliciano JD, Kajdas J, Finzi D, et al. Long-term follow-up studies confirm the stability of the latent reservoir for HIV-1
in resting CD4+ T cells. Nat Med. Jun 2003;9(6):727-728.

8. Mocroft A, Vella S, Benfield TL, et al. Changing patterns of mortality across Europe in patients infected with HIV-1.
EuroSIDA Study Group. Lancet. Nov 28 1998;352(9142):1725-1730.

9. Palella FJ, Jr., Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human
immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. Mar 26 1998;338(13):853-860.
10. Vittinghoff E, Scheer S, O'Malley P, Colfax G, Holmberg SD, Buchbinder SP. Combination antiretroviral therapy and
recent declines in AIDS incidence and mortality. J Infect Dis. Mar 1999;179(3):717-720.
11. ART CC AC. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a
collaborative analysis of 14 cohort studies. Lancet. Jul 26 2008;372(9635):293-299.
12. Mofenson LM, Lambert JS, Stiehm ER, et al. Risk factors for perinatal transmission of human immunodeficiency virus
type 1 in women treated with zidovudine. Pediatric AIDS Clinical Trials Group Study 185 Team. N Engl J Med. Aug 5
1999;341(6):385-393.
Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents D-2

Downloaded from http://aidsinfo.nih.gov/guidelines on 12/8/2012 EST.